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Highmark to institute new payment, treatment model for cancer care | TribLIVE.com
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Highmark to institute new payment, treatment model for cancer care

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Heidi Murrin | Tribune-Review
New techniques used at Allegheny Health Network can pinpoint small tumors in the breast.

Highmark Inc. is trying to make cancer treatment more efficient, effective and cheaper by creating incentives for doctors to follow national standards.

The insurer announced Wednesday that it had formed the Highmark Cancer Collaborative, which aligns treatment and payment for participating doctors with National Comprehensive Cancer Network guidelines. Doctors at Highmark-owned Allegheny Health Network, along with other doctors in Highmark’s networks, are participating.

If doctors follow the guidelines, fewer patients will undergo treatments that don’t work for them or that cause unnecessary side-effects, said Ginny Calega, Highmark’s vice president of strategic clinical solutions. By avoiding ineffective treatments, patients could recover quicker and pay less, Calega said.

“This is a really good way for the providers to be able to demonstrate to insurers like Highmark how well they’re doing and be able to objectively demonstrate their concordance with the gold standard,” Calega said.

With cancer treatments evolving on a “month-to-month basis,” the guidelines ensure that doctors are selecting treatments based on the latest advances, said Dr. David Parda, professor and system chairman of the Allegheny Health Network Cancer Institute.

“It’s something that is designed to have the best expert consensus guidelines available to our patients wherever we treat them in our 26 different sites throughout the region,” he said.

Doctors enter info such as the patient’s age, gender and the genetic profile of a tumor into an electronic system that matches them with the most current recommended treatments, which could involve chemotherapy drugs, radiation, surgery and other approaches, Parda said.

By agreeing to a standard set of best treatments, the arrangement eliminates the back-and-forth that often occurs as doctors and insurance companies debate how to treat a patient, he said.

“When you’re treating a cancer patient, there’s a lot of financial stress and strain and struggle that we want to take out of the system,” Parda said.

The system also matches patients with appropriate clinical trials, of which there are about 200 going on at Allegheny Health Network, Parda said. The collaborative includes a partnership with Johns Hopkins Kimmel Cancer Center, which expands access to hundreds more trials, he said.

Eventually all payments in the collaborative will be bundled, meaning that the insurer and the doctors agree before each treatment what the insurer will pay. Currently, only the payment for breast cancer radiation is bundled, Calega said.

Wes Venteicher is a Tribune-Review staff writer. Reach him at 412-380-5676 or [email protected].

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